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What Medication To Take For A Migraine

Diagnosis And Patient Assessment

The Different Medications Used To Treat Migraines

Migraine has well-established diagnostic criteria4 . Good evidence supports the use of the POUND mnemonic for migraine diagnosis6 . Assessment aims to confirm diagnostic criteria, evaluate for alternative explanations, identify comorbidities that could complicate management ,8 and document the baseline pattern and severity of episodes. A variety of conditions can present as headache, most of which can be identified by the history and physical examination .6 The only indications for ancillary testing are to identify causes of secondary headaches or comorbid conditions.9,10 Table 4 lists red flag symptoms that indicate the need for neuroimaging and/or urgent referral.9,10

International Headache Society Diagnostic Criteria for Migraine Headache With and Without Aura

Migraine without aura

*Recurrent disorder manifesting in headaches with reversible focal neurologic symptoms that usually develop gradually over 5 to 20 minutes before onset of the headache and last for less than 60 minutes. Headache with the features of migraine without aura usually follows the aura symptoms. Less commonly, headache lacks migrainous features or is completely absent .

Adapted with permission from Gilmore B, Michael M. Treatment of acute migraine headache . Am Fam Physician. 2011 83:272.

International Headache Society Diagnostic Criteria for Migraine Headache With and Without Aura

Migraine without aura

POUND Mnemonic for Diagnosis of Migraine

Clinical features:

Clinical features:

Important Note About ‘off

Many of the medications listed in this handout have not been approved by the Food and Drug Administration for use in children and adolescents with headaches. When a doctor chooses to prescribe a drug for a medical condition or for a certain patient type for which it has not received FDA approval, this practice is called off-label prescribing. This is a common practice in the field of medicine. It is one of the ways by which new and important uses are found for already approved drugs. Many times, positive findings lead to formal clinical trials of the drug for new conditions other than what the drug was first approved for.

Many of the drugs prescribed to help prevent head pain disorders are prescribed in this off-label fashion. Please check with your doctor regarding other medications not mentioned in this handout or if you have any concerns or questions.

Medication For Migraine Prevention

There are several drugs that can be taken to prevent migraine attacks or reduce their frequency or severity. You may be a candidate for preventive therapy if:

  • You have four or more migraine attacks per month.
  • Your migraine attacks last longer than 12 hours.
  • Pain-relieving medication is ineffective.
  • You regularly experience prolonged auras or numbness and weakness.
  • Your migraine attacks are disabling or adversely affect other medical conditions you have.

In general, your doctor may recommend that you take preventive medication daily or only when a predictable migraine trigger is approaching.

Many of the drugs that have been used in preventive therapy have not been specifically studied in clinical trials to target migraine. But that has recently been changing.

If taking a preventive medicine succeeds in stopping your migraine attacks, your doctor may recommend tapering off the medication to see if your attacks return without it.

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Medicines For Migraine When Pregnant Or Breastfeeding

Many of the medicines used to treat migraine should not be taken by pregnant or breastfeeding women.

  • For relief of a migraine headache:
  • Paracetamol is the medicine most commonly used, as it is known to be safe during pregnancy.
  • Ibuprofen is sometimes used but do not take it in the last third of the pregnancy .
  • Aspirin â avoid if you are trying to conceive, early in pregnancy, in the third trimester and whilst breastfeeding.
  • Triptans â should not be taken by pregnant women at all. Triptans can be used during breastfeeding, but milk should be expressed and discarded for 12-24 hours after the dose .
  • For feeling sick and being sick â no medicines are licensed in pregnancy. However, occasionally a doctor will prescribe one âoff licenceâ.
  • Medicines used for the prevention of migraine are not recommended for pregnant or breastfeeding women.
  • Check with your pharmacist or doctor if you are not sure.

    Also Check: How To Get Rid Of A Migraine Quickly

    Can A Migraine Cause A Stroke What Are The Risk Factors

    Why You Must Track Your Migraine Medication Use  Migraine ...

    Migraine and stroke may occur at the same time, but a causal link has not been established. When an ischemic stroke occurs during a migraine attack it is called a âmigrainous infarction.â The specific type of migraine associated with an increased risk of ischemic stroke is migraine with aura, a type of migraine that affects about one-quarter of all people with migraines. Rarely, people with specific migraine symptoms may be related to a higher risk of stroke.

    Migraines may be a risk factor for stroke, in that strokes occur more frequently in people who have had migraines, but the strokes do not necessarily occur during migraine attacks.

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    Drugs For Migraine Prevention

    If you have 4 or more migraine days each month, you may take these drugs regularly to keep migraine attacks from happening. They lessen the number of headaches you have and how severe they are.

    You have to follow your doctorâs directions for them to work. Your doctor may need to change the medications and adjust how much you take to figure out what works best for you.

    While youâre taking these drugs, write down how often you have headaches and how bad they are to help your doctor judge how well they are working. Most need days or weeks to take full effect.

    Once your headaches are under control for 6 months or a year, you might be able to taper off or stop these drugs. Your doctor will advise you.

    The medications listed include both over-the-counter and prescription drugs. They aren’t habit-forming, but any medication can have side effects. Your doctor will adjust the dosage to give you the most relief with the fewest side effects.

    Nonprescription Treatment Options For Migraine

    Emily M. Ambizas, PharmD, MPH, CGPAssociate Clinical ProfessorCollege of Pharmacy & Health SciencesQueens, New YorkClinical Specialist, Rite Aid PharmacyWhitestone, New York

    Alberto H. Ambizas, PharmD, CGPClinical Pharmacy SupervisorNorthport, New York

    US Pharm. 2016 41:31-34.

    Migraine headache is a common, debilitating condition affecting nearly 1 out of 7 Americans annually.1 This condition affects more women than men, and prevalence is highest during peak productive years, between the ages of 25 and 55 years.2 Migraine accounts for the majority of the 5 million headache visits to U.S. emergency departments annually.3 It has a major impact on quality of life more than 90% of migraine sufferers find it difficult to work or function normally during an attack, accounting for more than 150 million missed worked days, with an annual cost to employers exceeding $14 billion.4,5 In addition, migraine headache is ranked as the sixth highest cause of disability worldwide.6

    Pharmacists are in a unique position to help care for patients suffering from migraines. They are often the first healthcare professionals that patients will encounter when seeking relief for their migraine as many as 57% of patients self-medicate with OTC products.7 It is important for pharmacists to understand when and how to use OTC products for the management of migraines as well as when patients require referral to their healthcare provider.

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    How Should This Medicine Be Used

    Sumatriptan injection comes as a solution to inject subcutaneously . It is usually used at the first sign of a migraine headache. If your symptoms improve after you use sumatriptan but return after 1 hour or longer, you may use a second dose of sumatriptan. However, if your symptoms do not improve after you use sumatriptan, do not use a second injection without talking to your doctor. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use sumatriptan exactly as directed. Do not use more or less of it or take it more often than prescribed by your doctor.

    Sumatriptan injection comes in a pre-filled auto-injection device and in vials to be used with disposable syringes. If you are using vials of sumatriptan injection, your doctor or pharmacist will tell you what type of syringe you should use. Do not use any other type of syringe because you may not get the right amount of medication.

    You can inject your sumatriptan in the outer side of your thigh or upper arm. Do not inject sumatriptan through clothing. Never inject sumatriptan into a vein or muscle.

    You may use your first dose of sumatriptan injection in a doctor’s office or other medical facility where you can be monitored for serious reactions. Carefully read the instructions that come with your device, and ask your doctor or pharmacist to show you how to use it.

    When Are Opioids Or Butalbital Useful For Migraines

    Migraine Medications: What to take and what not to take.

    Your doctor may suggest an opioid if none of the treatments listed above help, or if you have bad side effects.

    It is not clear if butalbital should be used at all for treating migraines. If your doctor prescribes butalbital for your migraines, ask why. And ask if there are any other drugs that would work.

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    Which Medications Are Suitable For Children And Teenagers

    Medications sometimes have different effects in children and teenagers than they do in adults. They need other doses, and some of the side effects are also different. The following medications have been approved in Europe for the treatment of migraines in children and teenagers:

    • ibuprofen
    • acetaminophen : for children ages 12 and up, also in combination with metoclopramide
    • sumatriptan: as a nasal spray for children ages 12 and up

    It’s not clear whether acetaminophen can relieve migraine symptoms in children and teenagers. Several studies show that ibuprofen can help relieve migraine attacks. There were no serious side effects in the studies involving children with migraines. Mild side effects like stomach ache were rare.

    The sumatriptan nasal spray also helped relieve migraine attacks in children and teenagers. Mild side effects were more common though, such as an unpleasant taste or nausea.

    Children and teenagers can also be prescribed medication that hasn’t been approved for their age group. This is known as “off-label use.” If your doctor prescribes a medication off-label, then he or she needs to explain why and tell you about the associated risks.

    Aspirin Acetaminophen And Caffeine

    This OTC medication is actually a combination of three ingredients at a fixed dosage. These are:

    • aspirin
    • acetaminophen
    • caffeine

    Each of these ingredients has its own mechanism of action, which weve already discussed for aspirin and acetaminophen. What about caffeine?

    When you have a headache, blood flow is increased in your brain. Caffeine can cause blood vessels in the brain to constrict , reducing this blood flow. Caffeine also has anti-inflammatory properties and can enhance the effects of aspirin and acetaminophen.

    The combination of aspirin, acetaminophen, and caffeine is available OTC in a single dose pill or tablet.

    Like the OTC medications that weve already discussed, studies have been performed on the effectiveness of aspirin, acetaminophen, and caffeine. In fact, some studies have found it to be more effective than

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    For What Conditions Are Migraine Medications Used

    Some of the migraine medications used to treat or prevent migraine headaches are also used for other conditions. Here are the pain reliever medications for migraine therapy.

    • Antidepressants,

    There are some migraines drugs, though, that are used because they directly target the pain pathways associated with migraine headaches rather than pain pathways in general.

    Understanding Otc Medications For Migraines

    Migraine Medication Overuse: When Medications Trigger Your ...

    Many medications found on the shelves of drugstores these days were initially intended to be dispensed only with a prescription. In the United States, the prescription requirement is determined by the Food and Drug Administration . As long as a medication can be safely used by patients without physician oversight, the FDA will likely place it into one of the 80 OTC categories on the market.

    Prescription medications sometimes become OTC after they have been safely used by patients for a number of years. This is usually the case for non-habit forming medicines that do not have strong or dangerous side effects. Medications that have a solid record of safety and that do not present serious risks to the public are usually candidates for OTC status.Some OTC medications have the same active ingredients that can be found in prescription drugs, albeit at a lower therapeutic dosage. Physicians who specialize in treating migraine patients often recommend the use of OTC drugs for pain relief. When it comes to migraine prevention, however, doctors are more likely to reach for their pharmacy script pads.

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    What Drugs Are Good For Migraines

    If you have migraine attacks, try one of the drugs listed below. They all work best if you use them when the migraine is just beginning.

  • Start with a non-prescription pain drug that combines aspirin, acetaminophen, and caffeine . Or try non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen .
  • If these drugs do not help, or your headaches are more severe, try one of the prescription migraine drugs called triptans, such as sumatriptan .
  • If triptans do not work, try dihydroergotamine nasal spray . This drug works even better as an injection . You or your doctor can do the injection.
  • If you have migraines often, or if they are very severe, ask your doctor about drugs to prevent headaches.

    Strongest Migraine Medication Over

    When discussing strength, we often refer to how much of a medication is given per dose.

    Many of these OTC migraine medications are given in high doses. For example, the recommended dosages for aspirin and acetaminophen are typically around 1,000 mg.

    However, when thinking about strength, you may also be considering how strongly these medications act against your migraine symptoms.

    In this case, an argument can be made for the aspirin, acetaminophen, and caffeine combination. Older research has found that the combination of these three ingredients has a greater effectiveness than each individual ingredient alone.

    Overall, its important to remember that the medication that most effectively alleviates acute migraine symptoms can vary by person. Because of this, focus on finding the treatment that best addresses your symptoms.

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    How Should I Use Maxalt

    Take Maxalt exactly as prescribed by your doctor. Your doctor may want to give your first dose of this medicine in a hospital or clinic setting to quickly treat any serious side effects that occur.

    Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

    Take Maxalt as soon as you notice migraine symptoms.

    Take the regular tablet whole with a full glass of water. Maxalt may be taken with or without food.

    To take the orally disintegrating tablet :

    • Keep the tablet in its blister pack until you are ready to take it. Open the package and peel back the foil. Do not push a tablet through the foil or you may damage the tablet.

    • Use dry hands to remove the tablet and place it in your mouth.

    • Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. If desired, you may drink liquid to help swallow the dissolved tablet.

    After taking a tablet : If your headache does not completely go away, or goes away and comes back, take a second tablet 2 hours after the first. Do not take more than 30 mg of rizatriptan in 24 hours. If your symptoms have not improved, contact your doctor before taking any more tablets.

    After taking a tablet : If your headache does not completely go away, or goes away and comes back, contact your doctor before taking any more tablets.

    Never use more than your recommended dose. Overuse of migraine headache medicine can make headaches worse.

    Types Of Preventive Migraine Medicine

    Why Not Just Take Drugs for Migraines?

    The preventive medicine that are recommended to treat migraine fall into seven categories. Most preventive medications currently available are repurposed from other conditions. Here is an overview of each category, and tables of the different types of drugs in these categories and how they are taken can be downloaded here .

    Read Also: How Long Do Migraines Last For

    Cgrp Monoclonal Antibodies For Vestibular Migraine

    People with VM were excluded from the trials of anti-CGRP Migraine treatments so not much is known about their efficacy as a Vestibular Migraine treatment, yet Dr. David Dodick remains “cautiously optimistic” about them for the future.

    For Dr. Shin Beh, some initial success is being seen among dizzy patients. He says, “I’m finding that the CGRP monoclonal antibodies are helping Vestibular Migraine patients. I have a handful of patients on them at the moment. With more people using them, I’m sure we will draw a much clearer picture. For the Migraine rescue oral CGRP small-molecule blockers , I am waiting to hear back from the patients on their efficacy. They are still pretty new to the market, and I suspect insurance companies are still figuring out how to deal with them.”

    How Is Abdominal Migraine Treated

    Once a child is diagnosed with abdominal migraine, treatment generally falls into two categories: relieving symptoms during an episode and preventing future episodes.

    While there are few studies on the treatment and management of abdominal migraine, doctors may prescribe the following medications, based on their usefulness in treating migraines:

    • NSAIDs or acetaminophen to relieve the pain.
    • Triptans. This family of drugs is commonly used to treat migraine headaches and, if taken as soon as a migraine starts, can prevent symptoms from progressing.
    • Anti-nausea medication. Anti-nausea drugs act by blocking chemicals in the brain that trigger vomiting.

    Some studies have shown evidence to support the use of the following medications in preventing abdominal migraine:

    • Pizotifen, a benzocycloheptene-based drug.

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